Inspection on 03/08/07 for Far End

This inspection was carried out on 3rd August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Far End 27/07/09

Far End 09/01/06

Far End 05/01/06

Far End 19/07/05

Far End 21/02/05

Far End 16/08/04

Far End 24/02/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Far End Far End Sandhurst Lodge Wokingham Road Crowthorne Berks RG45 7QD Lead Inspector Stephen Webb Unannounced Inspection 3rd August 2007 09:45 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000011254.V345433.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000011254.V345433.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Far End Address Far End Sandhurst Lodge Wokingham Road Crowthorne Berks RG45 7QD 01344 772739 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) tddundas@totalise.co.uk Ms Patricia Trezise-Dundas Ms Dorinda Trezise-Dundas Ms Patricia Trezise-Dundas Care Home 3 Category(ies) of Dementia - over 65 years of age (1), Old age, registration, with number not falling within any other category (3) of places DS0000011254.V345433.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th January 2006 Brief Description of the Service: Far End provides care and accommodation for up to 3 people who are aged over 65 years of age and is situated in a peaceful location close to the village of Crowthorne. The home adjoins a large Victorian property with 14 acres of surrounding land which is also owned by the proprietors. The extensive grounds are well maintained consisting of lawns with mature shrubs and trees, and are enjoyed by the residents. There is a large aviary containing various birds, including chickens, geese and doves. The proprietors live on the ground floor of the home, which they share with a variety of animals, including both large and small dogs, cats and a caged bird, and though residents are said to be able to share the lounge/diner/kitchen with them, they do not opt to do so, preferring instead, to spend their time in their bed-sitting rooms and sometimes visiting each other therein. The residents each have their own single bed-sitting rooms on the first floor, where there is also a toilet, bathroom/toilet and a small kitchen area. The dogs remain in the ground floor areas, but the cats are popular visitors to the resident’s bedrooms. Residents are able to have pets of their own, and one has a pair of caged birds. The fees for the home at the point of inspection were £412.00 per week. DS0000011254.V345433.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection included an unannounced site visit from 9.45 until 16.15 on the 3rd of August 2007. This report also includes reference to documents completed and supplied by the home, and those examined during the site visit. The report also draws from conversations with the part-time staff member, and discussions with the manager and co-proprietor. The inspector spoke to the three residents during the inspection, on their return from the day centre, though only two were able to provide reliable answers. The inspector also examined the majority of the premises, particularly the resident areas on the first floor, including the bedrooms. The home had responded positively to the issues in the previous inspection report, and had addressed the majority of these, demonstrating a positive approach to the inspection process. This is an unusual service in that the residents each have a bed-sitting room and share communal bathing and toilet facilities, on the first floor, but there is no dedicated lounge or dining space, though residents are said to be able to share the proprietors’ lounge and dining facilities downstairs if they wish. What the service does well: Prospective residents undergo a pre-admission assessment to establish that their needs could be met by the home. The social and healthcare needs of residents are identified within their care plan and associated records, and appear to be met. The home has an effective system in place to manage the medication on behalf of residents for the most part. Residents feel they are treated with respect and the staff address their dignity and privacy effectively. Residents are satisfied that the opportunities for activities and community contact provided, meet their needs, and that their cultural and spiritual needs are met. The home positively supports residents in maintaining family contact, and arrangements are in place for a good level of day centre provision and a small amount of other community contact outside of this. DS0000011254.V345433.R01.S.doc Version 5.2 Page 6 Residents are enabled and supported to make some choices in their day-to-day lives consistent with their needs. The home provides a diet consisting primarily of pre-prepared purchased microwave meals, supplemented by home grown fresh vegetables and additional fruit, together with some home prepared snacks, complementing the main meals provided by the day centre, four days per week. The residents are happy that the meals meet their needs. Residents were aware they could raise any concern with the manager or staff. Systems and training are in place to protect residents from abuse. The environment provided for residents does not meet the usual expectations with regard to communal space, but meets the needs of the current residents who maintain a degree of self-mobility and are happy to spend the majority of their time in their bedroom, when not out at day centre or elsewhere. Some adaptations have been made to address residents’ needs and further developments and improvements are proposed. The laundry facilities are domestic in nature but meet the current needs of residents. Standards of hygiene in resident areas are good. The current needs of residents are met by the existing staffing arrangements. The management and staff receive appropriate core training. The home’s recruitment and vetting procedure provides protection to residents, and the manager agreed to undertake appropriate checks on any future volunteers to maximise this protection. The home is run by an experienced and appropriately qualified manager, who is also one of the co-proprietors, both of who live on site. Residents and their families have been consulted about their views of the service, though the response rate was limited. Residents’ financial interests are safeguarded and their health and safety promoted. What has improved since the last inspection? A daily record system has been introduced to record the activities and wellbeing of residents, though it needs to be individualised. The part-time staff member has now registered to undertake NVQ level 2. DS0000011254.V345433.R01.S.doc Version 5.2 Page 7 Individual risk assessments have been complete for each resident. A pair of caged birds has been purchased for one resident with dementia, to enrich her daily life experience. Details of the food provided by the home are now maintained alongside copies of the day care service menus to enable an overview of resident’s diet. All staff have commenced a comprehensive medication management course, and all medication is now secured in a locked cupboard. A quality assurance system has been put into operation. The fire officer has confirmed to the commission that the current fire safety provision at the home is satisfactory. What they could do better: The Statement of Purpose and separate residents’ information format both need to be updated as previously required, to accurately reflect the position with regard to the physical environment, and both documents should be dated. Some improvements in healthcare records are needed to better evidence how the home meets healthcare needs. A record of the quantities of all medication received into the home, must be made to provide the start of the medication audit trail, and medication administration instructions should always be available in writing, from the pharmacist or GP. No record of complaints/concerns was in place. The manager must establish a log for recording any concerns and complaints. A unit whistle-blowing policy/procedure must be established, to link in with the local multi-agency document. The current position regarding Safeguarding training for staff and volunteers, needs to be reviewed to ensure all have received the training recently, and are familiar with the vulnerable adults procedures. The current resident case records do not meet required standards and need to be improved. The outstanding electrical appliance testing must be arranged to ensure this is maintained and a unit fire risk assessment must be produced. The next cycle of quality assurance should be broadened to include surveys of the views of external healthcare professionals and care managers, and a brief summary of the outcome should be provided to participants. DS0000011254.V345433.R01.S.doc Version 5.2 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000011254.V345433.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000011254.V345433.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 3, and 6: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although a current Statement of Purpose and separate residents’ information format were available, neither of these documents had been updated as previously required, to accurately reflect the position with regard to the physical environment, and neither of them were dated. A satisfactory preadmission assessment format was in place to establish that a prospective resident’s needs could be met by the home. Standard 6 is not applicable since the home does not offer an intermediate care service. EVIDENCE: The residents’ records examined contained copies of satisfactory preadmission assessments, which provided information to inform the care plan, and of contracts/terms and conditions. DS0000011254.V345433.R01.S.doc Version 5.2 Page 11 Copies of the current Statement of Purpose and residents’ information (Welcome To Far End Residential Home) were provided to the inspector, but neither had been updated to clarify the situation regarding the absence of dedicated residents’ lounge and dining rooms, and neither was dated. These documents must be updated to clearly reflect the position with regard to the absence of dedicated lounge and dining areas, since these are normally an expected part of the provision within a care home, and should be dated to enable identification of the date of publication and when annual review is due. DS0000011254.V345433.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The social and healthcare needs of residents are identified within their care plan and associated records, and appear to be met, though some improvements in healthcare records are needed to better evidence this. The home has a system in place to manage the medication on behalf of residents, though a record of the quantities of all medication received must be made to provide the start of the medication audit trail, and administration instructions should always be available in writing, from the pharmacist or GP. Residents feel they are treated with respect and the staff address their dignity and privacy effectively. EVIDENCE: The two case records examined included a care plan detailing the individual’s needs in a range of areas. Each record also had a completed individual risk assessment format. DS0000011254.V345433.R01.S.doc Version 5.2 Page 13 The care plans identify healthcare issues and any spiritual needs as well as indicating some individual likes, dislikes and preferences. Though there were some letters etc. relating to individual healthcare needs, and appointments in evidence within the records examined, there was no systematic record of healthcare appointments and their outcome. At present these are being recorded within the new daily record sheets or the individual exercise books used for ongoing in-house review and consideration of needs. This would involve detailed reading of the two separate records to find reference to healthcare related matters therein. It is recommended that a specific format be established to record healthcare contacts, appointments and outcomes, in order to evidence that these are addressed effectively by the home, as this is not readily discernable from the current records. Residents’ chiropody needs are addressed through a visiting chiropodist at the day centre service. The home has a good relationship with a local GP practice who will visit when the manager feels this is needed. Residents’ emotional health needs have also been supported by staff in their daily contact and via the involvement of the CPN where necessary. The care plans included dates of review and evidence of periodic updates following these reviews. Some evidence of Local Authority reviews was also present. The new daily records, are a useful record of the day-to-day care input, activities and well-being of residents, but should be individualised so they can be retained as part of residents individual case records. The residents’ individual records are not currently secured in an orderly and systematic fashion and steps must be taken to address this. (Requirement made later in report under Standard 37). Feedback from two of the residents was positive about how their needs are met, and both spoke warmly about the employed staff member. The home has improved its storage of medication, with this now stored within a lockable cupboard in the upstairs kitchenette. At present the home administers no controlled drugs, but should this change in the future, consultation with the pharmacist should take place on upgrading the storage facilities for these. The medication administration record (MAR) sheets are used to record administration via staff initials, and any changes in medication are usually DS0000011254.V345433.R01.S.doc Version 5.2 Page 14 addressed via the provision of typed pharmacy labels, affixed to the MAR sheet. In one case, where the medication is prescribed other than by the GP, the administration dosage information had been hand-written on the MAR sheet, but the manager used the pharmacy label from one of the medication boxes as an interim measure during the inspection. Details regarding all medication administration, including any changes to prescribed medication should be supported in writing either from the pharmacist or the prescribing GP. The amounts of medication received by the home, were not being recorded either on the MAR sheet or separately, so there was no clear audit trail. A record of all medication coming into the home must be maintained, and it is suggested this be recorded and initialled in the places provided on the MAR sheets. The home has a separate log of medication returns. The manager and the one employed staff member are currently undertaking a thorough “Safe Handling of medicines” course. Residents privacy and dignity are provided for by them having individual bedsitting rooms of a good size, which are provided with a lockable door. Residents can see their visitors in their bedroom as each has sufficient space and seating provided for this. Where personal care support is given, this is behind closed doors and the bathrooms and toilets also have appropriate locks fitted. The manager indicated that where possible, residents are assisted into the bath and enabled to have some time to relax in the bath alone, before being supported to get out again. Residents open their own post, though one would be supported to do this, by staff, because they would not be able to interpret the content unaided. Two of the residents have emergency call bells within their room, which they can use when necessary to summon staff assistance, though one resident does not have this facility, as they are considered unable to make use of it. There is a telephone for residents’ use, in the kitchenette, and one resident also has her own mobile phone. DS0000011254.V345433.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The current residents are satisfied that the opportunities for activities and community contact provided, meet their needs, and that their cultural and spiritual needs are met. The home positively supports residents in maintaining family contact, and arrangements are in place for a good level of day centre provision and a small amount of other community contact outside of this. Residents are enabled and supported to make some choices in their day-to-day lives consistent with their needs. The home provides a diet consisting primarily of pre-prepared purchased microwave meals, supplemented by home grown fresh vegetables and additional fruit, together with some home prepared snacks, complementing the main meals provided by the day centre, four days per week. The current residents are happy that the meals meet their needs. DS0000011254.V345433.R01.S.doc Version 5.2 Page 16 EVIDENCE: Within the home residents spend time reading, knitting and doing crochet, watching TV, and one particularly enjoys looking out at the grounds and tending some planted pots outside her room on the patio. The manager indicated that the purchase of a people carrier was being considered in order to broaden the opportunities for community outings. One resident has discovered she very much enjoys painting, and has been provided with the equipment to encourage this. She showed me some of her paintings and said that some of the painting equipment had been given to her as a birthday present. She said that one of the other people she sees at the day centre helps and advises her on her painting. The same resident also enjoys crafts and makes her own birthday and Christmas cards. One resident who has dementia has been given a pair of caged songbirds that she enjoys having in her bedroom. One resident attends a weekly swimming session for people with disabilities, though this is now in a social capacity rather than to take part. Residents have been out for pub lunches, to a lake to feed the ducks and to a craft centre and café. There is room for some further development of outings such as these. All three residents attend a local day centre service in Sandhurst, four days per week, and one also attends a dementia unit on another day each week for activities. Activities at the day centre include art and crafts, bingo, exercises, music and games. Two residents were able to confirm that they enjoyed the regular day centre sessions, and one added that it was a chance to meet up with other people and friends. One resident used to be a regular at the local British Legion and is still collected and taken there sometimes by an old friend to catch up with her old acquaintances and play bingo. Two of the residents have a good level of family contact and one resident is visited and taken out every Sunday by her son. The other resident said family collect her and take her out too. She had recently been taken out to tea and was looking forward to attending an upcoming family wedding. The other resident is sometimes taken for supported visits to a family member in another care service, escorted by a staff member. The home had previously made physical adaptations to enable this resident to be visited by a disabled family member, and the manager reports that these DS0000011254.V345433.R01.S.doc Version 5.2 Page 17 and some of the other fire safety arrangements have been approved by the fire authority, although the home has nothing in writing to confirm this. One resident said she sometimes visits another resident in their bedroom, but does not choose to go downstairs to the provider’s lounge/dining facilities, preferring her own company most of the time. She does, however, enjoy the regular visits from one of the provider’s cats. Two of the residents were proud of their houseplants and one told me the special sentimental value which one of her plants held for her. Both of the more able residents commented that they very much liked the large gardens, and said that they could access these when the weather was good. One said she enjoyed feeding the birds. All three of the residents had very much personalised bedrooms, with lots of family photos and other mementos and personal items, and each had their own TV and other entertainment available. One resident said she had been told “It’s your room” and said she could have whatever pictures she wanted there. Neither of the more able residents had a desire to pursue their spiritual needs through going to church, though one confirmed she was of the Church of England faith, and said she could attend services at the day centre if she wanted. The manager said that the home has had visits from clergy in the past, where residents have wanted this, and had also sought church volunteers to escort residents to services. One resident is sometimes supported to attend church to meet up with her daughter and her carer. From this it would seem that individual spiritual and cultural diversity needs of residents would be met by the home where these were identified. Residents have opportunities to make some choices in other areas of their daily lives apart from menus, as they are supported or left to choose their own clothes, and can choose when to go to bed, though getting up times tend to be dictated by the need to be ready for the transport to day centre on four days per week. Residents also choose whether and when to undertake activities at the home. The home continues to provide a flexible menu, largely from purchased preprepared microwave meals, though the manager indicated these are mostly low fat, “healthy option” meals which are supplemented with home cooked fresh vegetables from the home’s garden, and also that additional fruit and biscuits are provided in residents’ rooms. Various home-cooked snacks may also be offered. The residents have a main meal at the day centre four days per week and one resident also has lunch at the dementia unit on another day. DS0000011254.V345433.R01.S.doc Version 5.2 Page 18 Residents are either given a choice of meal, or offered one that they are known to like, where they are unable to make a choice. The stated advantage of the use of pre-prepared meals is that a wider choice is available on any day. In response to previous questions about the meals provision, the manager now obtains the weekly menus from the day centre for comparison with the homes’ plans to avoid duplication and improve the overall dietary balance, though the specific advice of a dietician has not been sought to date. In conversation with the inspector, two of the residents expressed satisfaction about the food provided, and one noted that the manager also makes a very good omelette. Residents confirmed that they eat their meals in their bedrooms, and one said she sometimes joined another resident in her room for a meal. Neither felt they wanted to eat in the provider’s dining room downstairs. DS0000011254.V345433.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents were aware they could raise any concern with the manager or staff member, though no record of complaints/concerns was in place, and the manager indicated the last such issue raised, to have been in 2005. Systems and training are in place to protect residents from abuse, though a unit policy/procedure must be established, to link in with the local multiagency document. EVIDENCE: The home has a complaints procedure, which is included within the Statement of Purpose, but not mentioned within the residents’ information sheet. However, there was no complaints log in place, and the manager said that the last complaint had been in 2005. In the absence of a complaints log or recent records of complaints and their resolution, it was not possible to assess the procedure in action. The manager said that any concerns raised, were usually dealt with quickly and informally and so did not become a complaint as such. A complaints log must be established to record the basic details of any complaints or concerns raised, together with the action taken and outcome. DS0000011254.V345433.R01.S.doc Version 5.2 Page 20 Two of the residents were able to confirm that they would speak to the staff member or manager if they were unhappy about something, and felt that it would be dealt with. No complaints or concerns had been raised with the Commission, since the last inspection, for forwarding to the unit to be investigated. The home has a copy of the current local Safeguarding Adults Multi-Agency policy and procedure dated June 2006 The home’s whistle-blowing policy/procedure is a copy of the Bracknell Forest local authority one, and a local policy/procedure needs to be produced which relates to the specific circumstances, staff hierarchy etc. within the home. The manager and staff have undertaken training in safeguarding vulnerable adults, and have been POVA and CRB checked. However, the manager should check that “occasional” volunteers who cover the unit have also received the “Safeguarding” training. DS0000011254.V345433.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment provided for residents does not meet the usual expectations with regard to communal space, but meets the needs of the current residents who maintain a degree of self-mobility and are happy to spend the majority of their time in their bedroom, when not out at day centre or elsewhere. Some adaptations have been made to address residents’ needs and further developments and improvements are proposed. The laundry facilities are domestic in nature but meet the current needs of residents. Standards of hygiene in resident areas are good. EVIDENCE: The proprietors live on the ground floor of the home and though residents are said to be able to share the large lounge/diner/kitchen facilities there with them, the home’s Statement of Purpose and residents’ information still do not DS0000011254.V345433.R01.S.doc Version 5.2 Page 22 explicitly state this, and evidence suggests they do not opt to do so, since the ground floor of the house is dominated by the proprietors’ possessions and varied selection of pets, including cats, dogs and a caged bird. Discussion with two of the residents confirmed that they do not use the downstairs of the home, apart from accessing the garden and grounds. The manager indicated that some new residents have spent some time on the ground floor in the period after their admission but tend to do so less, once they have settled in. The residents’ accommodation is on the fist floor, and is reached via a staircase, which has two chair lifts on separate sections of it, with a short landing in between, which is provided with a foldaway device to facilitate access between the two stair lifts, for the disabled daughter of one resident, when she visits. The home does not have a lift. The device in place between the stair lifts would not be appropriate for use by a resident. The home would therefore only suit residents who retain a level of independent mobility, and the manager indicated that this is a major aspect of a resident’s pre-admission assessment. The flooring throughout the upstairs is vinyl and the manager indicated this was an aid to maintaining standards of hygiene. Standards of décor and furnishing on the first floor were satisfactory. There are no communal lounge or dining facilities on the first floor. The home would not be suitable for residents who were prone to wandering or displayed challenging behaviour. The three residents each have a bed-sitting room of sufficient dimensions to include armchairs or a sofa, and each bedroom was extensively personalised with the belongings and photographs of the resident. Also on the first floor are a bathroom with a hoist seat and a toilet and a further separate toilet. The manager indicated they are considering upgrading these facilities to include a modern bath with a hoist and a higher toilet. There is also a kitchenette, containing three microwave ovens, and a locked cupboard where the medication is stored. The unit does not have an integrated fire alarm system, but there are standalone mains electric smoke detectors throughout, and a heat detector in the kitchen. There is a mains electric torch on each floor, which comes on in the event of power failure to provide emergency lighting. Bedroom doors have been fitted with cold smoke seals and intumescent strips to reduce the risk of smoke spread in the event of fire. DS0000011254.V345433.R01.S.doc Version 5.2 Page 23 The fire officer has visited and inspected the fire detection system. The unit has an overall risk assessment dated 4/07. The home has obtained a grant to fund the upgrade of the bathroom facilities and also the replacement of the temporary wooden ramps at the front door with appropriate concrete ramps with handrails. The home has access to a large garden and also the wider grounds, which are also owned by the providers. One resident has some planted pots on a patio, which she likes to tend. The laundry is equipped with domestic machines and the manager indicated that these met the current levels of need, but would be kept under review. Standards of hygiene on the first floor were found to be good. DS0000011254.V345433.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The current needs of residents are met by the existing staffing arrangements. The management and staff receive an appropriate core training for their role and progress has been made with the registration of the part-time staff member for NVQ. However, the current situation regarding Safeguarding training for staff and volunteers, needs to be reviewed. The home’s recruitment and vetting procedure provides protection to residents, and the manager agreed to undertake appropriate checks on any future volunteers to maximise this protection. EVIDENCE: Since the staffing in the home is one person at a time, rotas as such, are not currently kept. However, the name of the staff member on duty is usually recorded within the diary, and it is suggested this is always done in order to ensure it would be possible retrospectively, to reliably identify the staff member on duty at any relevant time. Night staffing is provided by the live-in manager/provider. DS0000011254.V345433.R01.S.doc Version 5.2 Page 25 There had been no new staff recruited since the last inspection, so one or two issues raised at the last inspection were followed up this time. The two volunteers, who fill-in occasionally, both have current CRB checks, obtained via their other care jobs, in 2004 and 2005 respectively, copies of which were now on file in the home. In the past, one volunteer, who had been previously known to the provider, had been taken on without references. The provider/manager agreed that any future volunteers or staff would have references taken up on them, whatever the circumstances. A satisfactory core training, sourced either from the local Authority or independent trainers, has been attended by the manager and her coproprietor, and also provided for the one employed part-time staff member, (some of who’s training is provided by her other employer), including dementia care, food hygiene, first aid, fire safety, health and safety, and medication. However, the part-time staff member thought she had not yet done a “Safeguarding Adults” course, so this needs to be addressed as a priority. If the volunteers have not received this training recently either via Far End or in their other care roles, it is suggested they too attend this training. The Manager, her co-proprietor and the part-time staff member are currently undertaking a detailed medication management course. The manager has attained NVQ level 4 care and management and her Registered Manager’s Award and the part-time staff member has now registered to start her NVQ level 2 in September. Feedback from two of the residents was very positive about the manager and particularly about the part-time staff member, who one described as a “lovely carer”. It was evident from discussion that the residents had a good relationship with staff. DS0000011254.V345433.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37, and 38: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is run by an experienced and appropriately qualified manager, who is also one of the co-proprietors, both of who live on site. Residents and their families have been consulted about their views of the service, though the response rate was limited. Residents’ financial interests are safeguarded. The home does not manage their finances on behalf of residents, but provides family with itemised invoices and individual receipts for any expenditure on their behalf, for reimbursement. Residents’ rights and best interests are safeguarded, for the most part, but the current resident case records do not meet required standards and need to be improved. DS0000011254.V345433.R01.S.doc Version 5.2 Page 27 The home addresses the health and safety of residents for the most part, though the outstanding electrical appliance testing must be arranged to ensure this is maintained and a unit fire risk assessment must be produced. EVIDENCE: The co-provider/manager is appropriately experienced and qualified to manage the home. She has attained NVQ level 4 in care and management and her Registered Manager’s Award, and attends local provider meetings to keep up with developments, as well as attending regular training alongside the parttime staff member and her co-proprietor. The manager had undertaken a survey of residents and relatives, during June and July of 2007, and received one completed form back from family and one from a resident, both of which had expressed positive feedback about the service. A summary report was not produced owing to the low return rate and small size of the home. It is suggested that the next round of surveys includes questionnaires to external healthcare professionals and funding authorities in order to obtain as wide a cross-section of views about the service as possible, and that a brief summary of the results is provided to participants, in order to inform them of outcomes and encourage future participation. One resident confirmed to the inspector that she had been asked her views about the home. One resident was very complimentary about the home’s grounds, which she enjoyed, and also the various animals about the home. One resident manages her own finances, which are managed by family, on behalf of the other two residents. The home does not hold or manage residents’ money but provides the family with a periodic itemised invoice, which is cross-referenced to the individual receipts, for any monies spent on behalf of residents. As noted earlier in the report, the residents’ case records were not secured in an orderly and systematic fashion. Residents’ case records need to be held securely to prevent loss, and should be filed in a systematic way in order for them to remain clear, and to enable key information to be readily located. It is recommended that the case records be secured within individual files, with an index and appropriate category separation. Examination of a sample of required health and safety-related service certification indicated that the majority of servicing was up to date with the exception of the annual electrical testing of portable appliances, which was overdue and needed to be booked. DS0000011254.V345433.R01.S.doc Version 5.2 Page 28 There was also no overall fire risk assessment for the unit, and the manager must ensure that this is undertaken and recorded as a priority and reviewed annually thereafter. The required tear-off accident pad was in place but there had been no recent accidents. The manager indicated that the last one had been in 2003. Following discussion it was agreed that copies of any future completed accident form would be placed on the relevant resident’s case record and within a collective record for monitoring. DS0000011254.V345433.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X 2 2 DS0000011254.V345433.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4&5 Requirement The manager must ensure that the Statement of Purpose and Resident’s Guide are updated to clearly describe the situation regarding the physical environment. Timescale for action 03/09/07 2 OP9 13(2) 3 OP16 22 4 OP18 13(6) 5 OP30 13(6) This requirement remains outstanding from the last inspection report (deadline 09/04/07), and is now subject to a new deadline. The manager must ensure that a 03/09/07 record of all medication coming into the home, is established and maintained as part of the required medication audit trail. The manager must establish a 03/09/07 central log of complaints, wherein any concerns or complaints raised, should be logged together with details of their investigation and resolution The manager must compile a 03/10/07 local whistle-blowing policy / procedure which relates to the circumstances in the home. The manager must review the 03/10/07 situation with regard to DS0000011254.V345433.R01.S.doc Version 5.2 Page 31 6 OP37 17 7 OP38 13(4) 8 OP38 23(4) “Safeguarding Adults” training to ensure that all employees and volunteers have received this training from an appropriately qualified trainer. The manager must take steps to 03/10/07 make sure that residents’ case records are secured and in good order. The manager must arrange for 03/09/07 the electrical testing of all portable electrical appliances throughout the home. The manager must produce a fire 03/10/07 risk assessment for the home, and keep this under regular review. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP1 OP8 OP9 Good Practice Recommendations The Statement of Purpose and Residents Information sheet should be dated to enable the date of publication and due date of review to be identified. The manager should establish a systematic format for recording the healthcare appointments and outcomes for each resident, within their case record. The manager should ensure that all medication administration instructions, (including any changes to prescribed medication) are supported in writing, either from the pharmacist or the prescribing GP. It is recommended that the volunteers are made familiar with the Vulnerable Adults procedure, and attend the “Safeguarding” training. It is suggested that the next cycle of quality assurance be broadened to include surveys of the views of external healthcare professionals and care managers, and that a brief summary of the outcome is provided to participants. 4 5 OP18 OP33 DS0000011254.V345433.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000011254.V345433.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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